Provider Demographics
NPI:1174143655
Name:NEIGHBORHOOD HEALTH RX CORP.
Entity type:Organization
Organization Name:NEIGHBORHOOD HEALTH RX CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSHEYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-997-7700
Mailing Address - Street 1:10018 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4515
Mailing Address - Country:US
Mailing Address - Phone:718-997-7700
Mailing Address - Fax:718-997-7707
Practice Address - Street 1:10018 67TH AVE
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4515
Practice Address - Country:US
Practice Address - Phone:718-997-7700
Practice Address - Fax:718-997-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-24
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06442204Medicaid